脑心通治疗阻塞性睡眠呼吸暂停低通气综合征的疗效研究

Curative effect of Naoxintong on obstructive sleep apnea hypopnea syndrome

目的探讨脑心通治疗阻塞性睡眠呼吸暂停低通气综合征(OSAHS)的疗效,为临床治疗提供依据。方法选择2016年4月至2017年3月浙江医院呼吸科收治的96例OSAHS患者为研究对象,随机分为联合治疗组和对照组,每组48例。对照组采用持续正压通气(CPAP)治疗。联合治疗组在对照组的基础上,采用脑心通胶囊治疗。采用多导睡眠监测仪对患者进行夜间7 h动态监测,记录呼吸暂停低通气指数(AHI)、最低脉氧饱和度(LSpO_2)、平均脉氧饱和度(ASp O_2)和氧减指数(ODI);测定两组患者治疗前后神经元特异性烯醇化酶(NSE)、S-100β蛋白、丙二醛(MDA)、缺血修饰白蛋白(IMA)和晚期蛋白氧化产物(AOPP)的水平。采用蒙特利尔认知评估量表(Mo CA)评估患者认知功能。采用沃斯嗜睡量表(ESS)评估患者日间嗜睡情况。用SPSS 19.0软件进行χ2检验、独立样本t检验和配对t检验。结果与治疗前比较,两组患者治疗后的AHI、ODI明显降低,LSpO_2、ASp O_2明显升高,差异均有统计学意义(P<0.05);治疗后,联合治疗组的AHI、ODI明显低于对照组,LSpO_2、ASp O_2明显高于对照组,差异均有统计学意义(P<0.05)。两组患者治疗后的NSE、S-100β蛋白、MDA、IMA和AOPP均较治疗前明显降低,差异均有统计学意义(P<0.05);治疗后,联合治疗组的NSE、S-100β蛋白、MDA、IMA和AOPP明显低于对照组,差异均有统计学意义(P<0.05)。联合治疗组治疗后的MoCA总分明显高于本组治疗前,且高于对照组治疗后,差异均有统计学意义(P<0.05)。两组患者治疗后的ESS评分明显低于本组治疗前,差异均有统计学意义(P<0.05);治疗后,联合治疗组ESS评分明显低于对照组,差异有统计学意义(P<0.05)。结论脑心通胶囊联合CPAP治疗可改善OSAHS患者的认知功能,减轻氧化应激反应。

Objective To investigate the curative effect of Naoxintong on obstructive sleep apnea hypopnea syndrome（OSAHS）, and to provide the basis for clinical treatment. Methods The subjects were 96 patients with OSAHS in the department of respiration of Zhejiang Hospital from April of 2016 to March of 2017. The subjects were divided into the combined treatment group and the control group（48 cases for each group）. The control group was treated with continuous positive pressure ventilation（CPAP）. The combined treatment group was treated with Naoxintong capsule on the basis of the control group. The patients were monitored by night monitoring for 7 h, and the apnea/hypopnea index（AHI）, the minimum pulse oxygen saturation（LSpO2）, the mean pulse oxygen saturation（ASp O2） and the oxygen reduction index（ODI） were recorded. The levels of neuron specific enolase（NSE）, S-100βprotein, malondialdehyde（MDA）, ischemia modified albumin（IMA） and late protein oxidation product（AOPP） in two groups before and after treatment were detected, respectively. The cognitive function of patients was assessed by the Montreal cognitive assessment scale（Mo CA）.The day sleepiness（ESS） was used to assess the daytime sleepiness for all subjects. The chi square（χ^2）test, independent sample t test and paired t test were used to analyze the data by software SPSS 19.0. Results As compared with the pre-treatment, the AHI and ODI were significantly decreased, and the LSpO2 and ASp O2 were significantly increased in two groups（P〈0.05）. After treatment, the AHI and ODI in the combined treatment group were significantly lower than those in the control group,and the LSpO2 and ASp O2 in the combined treatment group were significantly higher than those in the control group（P〈0.05）. The NSE, S-100β protein, MDA, IMA and AOPP after treatment were significantly lower than those before treatment in the two groups（P〈0.05）. After treatment, the NSE, S-100β protein, MDA, IMA and AOPP in the combined treatment group were significantly lower than those in the control group（P〈0.05）. The total score of MoCA after treatment was significantly higher than that before the treatment in the combined treatment group, which was higher than that in the control group（P〈0.05）. The total scores of ESS after treatment were significantly lower than those before treatment in two groups, respectively（P〈0.05）. After treatment, the ESS score in the combined treatment group was significantly lower than that in the control group（P〈0.05）. Conclusion Naoxintong capsule can improve the cognitive function and alleviate the oxidative stress response in OSAHS patients.